[N105] Nursing Care for Perioperative Patients

Operating room

Operating room

A sterile environment where surgeries are performed by trained medical professionals using specialized surgical instruments

Diagnostic, Palliative, Ablative, Constructive, Transplant

Types of surgeries according to purpose: DPACT

Elective

This is the type of surgery performed when surgical intervention is the preferred treatment, not imminently life-threatening

Emergent surgery

This type of surgery cannot be postponed for more than 1 hour after it is scheduled.

Urgent surgery

Type of surgery that must be carried out within 24-48 hours

Directional elective surgery

Type of surgery that can be performed 3 months after it is scheduled

Minimally-invasive surgery (MIS)

Surgery performed in a body cavity or body area through one or more endoscopes

resection of appendix

Identify the procedure: Appendectomy

resection of the gall baldder

Identify the procedure: cholecystectomy

division of the vagus nerve

Identify the procedure: vagotomy

gastric resection

Identify the procedure: gastrectomy

muscle suturing

Identify the procedure: myorrhaphy

cutting into the chest

Identify the procedure: Thoracotomy

Cutting into the uterus

Identify the procedure: Hysterotomy

False. It is not imminently life-threatening.

T or F: A patient for cholecystectomy for chronic gallbladder disease requires an emergent surgery as it needs immediate attention since this disorder might be life-threatening

True

T or F: In the case that an unconscious patient with severe injuries due to a mass vehicular accident is brought to the hospital needing an emergent surgery, consent may not be needed.

Minimally-invasive surgery can correct Problems, remove Organs, take Tissues for Biopsy, and reroute Blood Vessels and Drainage Systems.

Minimally-invasive surgery can correct P, remove O, take T for B, and reroute BV and DS.

Malnutrition/obesity, Cardiac condition, Blood coagulation disorders, URTIs/COPD, Renal disease, DM, Liver disease, uncontrolled neurologic disease

Physiologic health concerns that increase surgical risk.

Mood factors, Attitudinal factors, Personality traits

Psychological health concerns that increase surgical risk.

Pre-operative phase

Refers to the time interval that begins when the decision for surgical intervention is made until the client is transported to the OR.

GOAL: the patient to be in the best possible physical and emotional condition for surgery

FOCUS: preparation of the patient

Goal and focus of the nurse during the pre-operative phase

1. Anticoagulants - risk for bleeding

2. Diuretics - risk for volume loss (hypovolemic shock)

3. Tranquilizers - risk for increased sedation

4. Adrenal steroids - lower pain tolerance

5. Antibiotics in "mycin”group - risk for infection

Surgical risk for medications

1. A

2. D

3. T

4. AS

5. A

Pre-operative: Inside the physician's office during consultation [most ideal]/2 days/night before the surgery

When is the best time to teach the patient for surgery?

Anesthesiologist

Who does the preoperative anesthesia evaluation?

Patient's:

1. previous experience

2. known importance of the surgery

3. educational level

4. sensory impairments

5. expectations

6. availability of support systems

What does preoperative educational assessment consist of?

Sensory, Psychosocial, Procedural

Preoperative teaching involves 3 aspects: SPP

6 hours prior to surgery: solid foods

2 hours prior to surgery: clear fluids

Protocol done in terms of NPO

Make-up, nail polish, dentures, metal objects

Prior to surgery, patients should remove their?

Visualization: We let them see a video clip of what will happen in the OR.

How do we address misconceptions or any incorrect information during the preoperative teaching?

DBE, turning every 2 hours, exercise, when to ambulate, pain control

Give post-operative health teaching activities that the client may perform as indicated.

Complete bed bath

What type of bath must be performed before a surgery?

Aspiration pneumonia

Patients should maintain NPO as ordered to prevent?

Enhanced recovery after surgery (ERAS)

An evidence-based approach to surgical care aimed at minimizing the stress of surgery and supporting patients to recover quickly through maintenance of normal physiology.

Both vices should be stopped 4 weeks before surgery

What should a nurse ask/advise to a patient who smokes and drinks alcohol scheduled for surgery?

1. Invasive procedures

2. Procedures involving sedation or anesthesia

3. non-surgical procedures

4. procedures involving radiation

5. blood transfusion

Informed consent is necessary in what circumstances?

Operation, Anesthesia, Blood Transfusion

Three consents (ABO)

Guideline

A set of sequential steps that should be followed in a particular order, enabling the task to be completed.

Protocol

Implemented to make sure certain mandatory items are not forgotten.

• Deficient Knowledge related to unfamiliar surgical experience

• Anxiety and fear related to pain, death, disfigurement, or the unknown

NDx for patients during the Pre-operative phase

True

T or F: A patient without sedation can still withdraw consent minutes before surgery.

False. Special orders are completed immediately prior to wheeling.

T or F: An IV line ordered for surgery may be started inside the OR.

Anticholinergics (i.e. atropine)

These medications are administered to reduce the amount of secretions as ordered.

Intraoperative phase

Refers to the time interval that begins when the patient is transferred to the OR and ends when patient is transferred to the post anesthesia care unit.

Hemodynamic stability

What do we maintain during the intraoperative phase?

Label the members of the surgical team

The patient to be in best possible physical and emotional condition for surgery

What is the nurse’s goal during the Intraoperative phase?

Operating surgeon

Identify the member of the surgical team: Performs the operation, post-op management & care. Assumes all responsibility for all medical acts of judgment & management.

Surgical assistant

Identify the member of the surgical team: Supports the operating surgeon. Scrubs and assists in performing the surgery

Anesthesiologist (or Nurse Anesthetist)

Identify the member of the surgical team: Administers the anesthetic agent and monitors the patient’s physical status throughout the surgery.

Circulating Nurse

Identify the member of the surgical team: Ensures everything in the surgical checklist: consent, antibiotics, IV line. Assess the client preoperatively. Plans for optimal care during surgery. Coordinates all personnel in the OR (monitoring of unlicensed personnel)

Circulating nurse

Who coordinates with the blood bank during surgery?

Circulating nurse

Who performs surgical skin preparation during surgery?

Unrestricted area

This area provides an entrance to and exit from the surgical suite. It contains the holding or admission area and PACU.

True. Street clothes are permitted.

T or F: The healthcare team may wear street clothes at the unrestricted area

Semi-restricted area

This area provides access to the procedure rooms and peripheral support areas within the surgical suite

Restricted area

This area includes the procedure room in which surgery is performed and adjacent sub-sterile areas where the scrub sins and autoclaves are located

Scrub nurse

Who prepares and anticipates all needed supplies and instruments using sterile technique prior to surgery?

Scrub nurse

Who performs the aftercare of the patient?

Foreign object retention

The CRN and scrub nurse keeps accurate count of sponges, sharps, and instruments during surgery to prevent?

Registered nurse 1st assist

A perioperative nurse who has had additional specialized education and works directly with primary surgeon

Personnel, Contaminated inanimate objects, Air, Human error

Sources of contamination (P,CIO,A,HM)

24 deg cel

OR temperature should be maintained at what degree?

1. Increased cost

2. Longer hospital stay

3. Increased recovery time

Why do we prevent surgical site infection?

HazMat Suit - Level 4

PPE worn during a pandemic

To prevent bacterial growth

Why do we maintain cool temperature inside the OR?

Intraoperative record

This serves as documentation of what transpired during the intraoperative phase.

Instrument/sponge count

This serves as detailed documentation of what sterile supplies were used during surgery

Anesthesia

An artificially induced state of partial or total loss of sensation with or without loss of consciousness

General anesthesia

This anesthesia blocks pain stimuli from the cerebral cortex and depresses the CNS.

General anesthesia

What type of anesthesia is best suited for surgery of the head & neck, upper torso and back?

• Cardiac and respiratory functions are regulated

• Can be adjusted to the length of the operation and the client’s age and status

• Ensures cooperation

Advantages of general anesthesia

• Cardiac and respiratory functions are depressed

• Increased anxiety

Disadvantages of general anesthesia

Inhalation anesthesia

This type of anesthesia is produced by having the patient inhale the vapors of certain volatile liquids or gases.

Sore throat (d/t trauma of larynx s/t balloon of endotracheal tube)

Major complication of inhalation anesthesia

Intravenous anesthesia

This is frequently administered as an adjunct to inhalational agents as it provides reversible, safe state of anaesthesia

Respiratory depression

Major complication of IV anesthesia

Regional anesthesia

This anesthesia blocks pain stimulus at its origin, along different neurons, or along the spinal cord

Regional anesthesia

Type of anesthesia used in cesarian section

• less systemic effects, client remains conscious

• Safer than general anesthesia

Advantages of regional anesthesia

Fetal position

Position used for spinal anesthesia

False. It can cause paralysis of the diaphragm.

T or F: Spinal anesthesia may be used for an upper body surgery.

• Excellent lower body muscle relaxation (lower part of the body)

• No effect on consciousness

• Relatively safe

• Preferred for older adults

Major advantages of spinal anesthesia are?

Epidural anesthesia

This type of anesthesia produces autonomic nerve blockade

• hypotension

• respiratory depression

• paralysis

Potential problems in administering an epidural anesthesia

Caudal anesthesia

Introduction of an anesthetic agent into the caudal or sacral canal.

Topical anesthesia

This anesthesia can be directly applied onto the area to be desensitized. It is short-acting and can block nerve endings in the mucous membranes of the vagina, rectum, nasopharynx, and mouth

Topical anesthesia

Gingival gel is under what type of anesthesia?

Local infiltration

Injection of an anesthetic agent into the skin and subcutaneous tissues. This blocks only peripheral nerves around the area of incision

Field block

Anesthetic barrier formed between the incision and the nervous system.

IV regional extremity block (Bier block)

This type of anesthesia uses a tourniquet to prevent absorption of the anesthetic beyond the involved extremity.

Peripheral nerve block

A nerve block anesthetizes individual nerves or nerve plexuses rather than all the local nerves anesthetized by a field block.

Conscious sedation

With this anesthesia: A nerve block anesthetizes individual nerves or nerve plexuses rather than all the local nerves anesthetized by a field block.

Malignant hyperthermia

A life-threatening complication of general anesthesia due to a defect in the sarcoplasmic reticulum where the triggering agents sets off the release of calcium.

Primary surgeon/Circulating nurse

Who calls for timeout?

optimal positioning

In addition to providing the best possible access to the surgical site, _______________________ prevents long- term complications such as nerve injury or pressure ulcers.

Lithotomy

Position for vaginal operations

Lateral

Position for kidney procedures

Jacknife

Position for hemorrhoidectomy

Post-operative phase

Refers to the time interval that begins when the patient leaves the OR and is transferred to the PACU and continues until discharge (transfer to PACU to discharge)